Note: Much of the toxicological data in this monograph is based on the European white hellebore (Veratrum album), as both American hellebore and European white hellebore contain jervine alkaloids, the constituents responsible for the plants' toxic cardiovascular effects.

American hellebore is a perennial plant native to the swampy areas and moist meadows of the eastern and western United States. The root and rhizome of American hellebore has been used historically for fever, pain, and high blood pressure, with a decoction (boiled in water) of the root being used for chronic coughs and constipation. Historically, the whole plant was not routinely used medicinally, only the root and rhizome. Although American hellebore was formerly used as a tea or tincture, potentially toxic and irritating constituents preclude its modern day use by ingestion.

The toxic effects associated with American hellebore limit its ability to be used as an agent to treat hypertension (high blood pressure), related kidney/heart diseases, and hypertension associated with pre-eclampsia in pregnancy.

Currently, there is a lack of scientific information regarding the safety or effectiveness of American hellebore as a whole plant, or homeopathically. Most studies have investigated the isolated jervine alkaloids.

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

GRADE *

Isolated jervine alkaloids found in American hellebore have been studied for cardiovascular and renal (kidney) dysfunction. Additional study is needed before a firm recommendation can be made.

C

Isolated jervine alkaloids found in American hellebore have been used to treat hypertension, however other herbs and prescription drugs that can treat this condition have fewer toxic side effects. Additional study is needed in this area.

C

Isolated jervine alkaloids found in American hellebore may be beneficial for pre-eclampsia/pregnancy-induced hypertension, but other herbs and prescription drugs that can treat this condition have fewer toxic side effects. Additional study is needed in this area.

C

* Key to grades

A: Strong scientific evidence for this useB: Good scientific evidence for this useC: Unclear scientific evidence for this useD: Fair scientific evidence for this use (it may not work)F: Strong scientific evidence against this use (it likley does not work)

Tradition / Theory
The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

There is currently a lack of available scientific information about safe or effective dosing of American hellebore in adults. Most preparations used in studies contain isolated jervine alkaloids from American hellebore (Vertavis®, Veratrone®), and no doses of whole American hellebore have been noted.

Children (younger than 18 years)

There is currently a lack of available scientific information about safe or effective dosing of American hellebore in children.

Safety
The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

Avoid in individuals with a known allergy or hypersensitivity to plants in the lily family (Liliaceae) or a known allergy to American hellebore or any related species of Veratrum.

Side Effects and Warnings

It appears that American hellebore is not well tolerated in humans. Even at recommended doses, American hellebore may cause toxicity that may result in death. The isolated chemical constituents (steroidal alkaloids) have been reported to cause arrhythmias (irregular heartbeat), bradycardia (slowed heart rate), hypotension (low blood pressure), headache, nausea, vomiting, diarrhea, gastrointestinal upset and altered renal (kidney) function. Patients with cardiovascular disorders should use caution when taking American hellebore.

Homeopathic American hellebore may be safe for use, but currently there is a lack of available information regarding side effects.

Pregnancy and Breastfeeding

American hellebore should be avoided in pregnant and breastfeeding women since it may be toxic even at therapeutic doses.

The use of American hellebore or its alkaloidal constituents could cause bradycardia (slowed heart rate) and combination with anti-arrhythmic drugs may be unsafe. Caution is advised.

American hellebore or its alkaloidal constituents may lower blood pressure. Patients taking medications that lower blood pressure (antihypertensives) should consult with a qualified healthcare professional, including a pharmacist.

American hellebore or its alkaloidal constituents may cause a decrease in glomerular filtration rate (GFR) and effective renal blood flow. Thus, American hellebore may interact with certain medications that increase urine flow (diuretics) such as chlorothiazide (Diuril®). Preparations of American hellebore may also interact with drugs that are excreted through the kidneys or that are potentially toxic to the kidneys.

Isolated constituents found in American hellebore may have beta-agonist and/or beta-adrenergic blocking activity. Caution is advised in patients with cardiovascular disease or those taking beta-agonist or beta-blocker drugs.

Interactions with Herbs and Dietary Supplements

The use of American hellebore or its alkaloidal constituents could cause bradycardia (slowed heart rate) and combination with anti-arrhythmic herbs and supplements may be unsafe. Caution is advised.

American hellebore or its alkaloidal constituents may lower blood pressure. Patients taking herbs and supplements that lower blood pressure (antihypertensives) should consult with a qualified healthcare professional, including a pharmacist.

American hellebore or its alkaloidal constituents may cause a decrease in glomerular filtration rate (GFR) and effective renal blood flow. Thus, American hellebore may interact with certain herbs and supplements that increase urine flow (diuretics). Preparations may also interact with herbs and supplements that are excreted through the kidneys or that are potentially toxic to the kidneys.

The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.